A National Appeal to Mr. President

A National Appeal to Mr. President

WHO Framework Convention on Tobacco Control (WHO FCTC): the success, challenges and prospects in nigeria

Who framework convention on tobacco control (who fctc): the success, challenges and prospects in nigeria

WHO Framework Convention: The Reality in Nigeria

In the year 2003, over 140 countries converged in Geneva, Switzerland under the auspices of the World Health Organisation (WHO) to enact the first global public health treaty – WHO Framework Convention on Tobacco Control (WHO FCTC). The aim was to establish guidelines that would serve as the basis for controlling global tobacco consumption and the associated tobacco-related diseases and deaths. Today, over 170 countries including Nigeria are signatories to this treaty.
The components of the FCTC include; taxation on tobacco products that is continuously adjusted to the annual inflation rate, smoke-free public places, health education about the health damaging effects of tobacco smoking and second hand smoke, health warnings on tobacco products-to include pictures or pictograms on cigarette packages, ban on advertisement, promotion or sponsorships by tobacco companies, regulation of tobacco products, tobacco products disclosures, provision of viable economic alternatives to tobacco farmers e.t.c
The domestication of the WHO FCTC by most developed countries to protect their citizens from the harmful effects of tobacco, has translated to marked reduction in tobacco consumption in these countries. The effect of which is the migration of tobacco companies to developing countries where there is no effective legislation to curb their activities.
The single most effective way of controlling tobacco use in any country is through increased taxation of tobacco products. The massive influx of the said industry into developing countries like Nigeria is largely due to the relatively weaker taxation on tobacco in comparison to developed countries. Increased taxation leads to an increase in the price of cigarettes, making it less affordable to the youths and the poor, who are most sensitive to price changes and are also worst hit by tobacco-related diseases.
In Nigeria, a pack of cigarettes goes for about N200 compared to about seven pounds (N1750) in the United Kingdom. Therefore, cigarettes are readily available and affordable to the youths and the poor, who lack the financial wherewithal to treat tobacco-related diseases.
An effective legislation to protect Nigerians from the harmful effects of second hand smoking is lacking. As a result, the whole population including pregnant women and children are still at risk of the health hazard associated with second hand smoking. The Federal Capital Territory (Abuja) and Osun state made some effort to enact smoke-free legislation sometimes in the past. While this is quite encouraging, emphasis should be placed on the enforcement of this legislation in these regions in order to achieve the desired goal.
Furthermore, strategic and effective tobacco control communication is deficient in Nigeria. The level of awareness about the dangers of tobacco smoking, particularly second hand smoking is very low.
Though, the government has been able to compel the tobacco industry to increase the size of the health warnings on cigarette packs to about 30% of the surface of the pack, this has not significantly translated to the dissuasion of smokers from smoking.
The tobacco industry is still involved in some promotional and sponsorship activities.
Smokers willing to quit cannot get professional help, as tobacco dependence treatment clinics are yet to be established.
Also lacking is a National body that regulates the composition of tobacco products and tobacco industry foreclosures to ensure that tobacco products meet up with international standards.
Government’s assistance to tobacco farmers to aid crop diversification and enable them to switch to the cultivation of other economically viable alternatives has been grossly inadequate. Conversely, the tobacco industry gives huge technical assistance to these farmers in order to boost tobacco production in Nigeria.
Summarily, one can say that Nigeria has not been successful in the implementation of the FCTC guidelines, but that would be totally untrue. On Tuesday 18th March 2011, the Nigeria Senate passed the Nigeria National Tobacco Control Bill (the domesticated version of the FCTC guidelines in Nigeria) into law, after over two years of delay. Though as of the time of this writing, the bill still awaits reconciliation in the House of Representatives and subsequently the presidential assent, the passage of the bill by the senate marks the real beginning of tobacco control in Nigeria.
Kudos should be given to the stakeholders that worked assiduously to ensure the implementation of this bill. However, they should continue to ensure that the full implementation and enforcement of the bill effectively translates to a decline in the smoking population and also in tobacco-related diseases and deaths in Nigeria. Also, they should be ready to resist all efforts by the tobacco industry to nullify the benefits of the passed bill.
In conclusion, every year about 5 million people die globally from tobacco consumption and 600,000 from exposure to second hand smoke. Statistics would remain just numbers until a neighbour, friend or relative gives it a human face. The Nigeria Senate has taken the huge step of saving Nigerians from the tobacco epidemic by passing the tobacco control bill into law. However, this gain should be concretized by the House of Representatives, who are presently being awaited to reconcile this bill and subsequently forward it for presidential assent before the expiration of the current political dispensation.

Smoke-free public places: Taking a cue from Spain

A new year ushers in good tidings and new beginnings. For Spaniards, it was the beginning of a new era, as their government was ready to start the year on a “clean bill of health” and taking their health as top priority.
On the 2nd of January, 2011, the Spanish government placed a complete ban on smoking in public places. These include bars, restaurants, casinos, workplaces, other enclosed public places and even outdoor areas such as playgrounds, hospital yards e.t.c . Non -compliance with this ban attracts a fine of $40 and as high as $100,000 if caught three times.
Spain is not the first country to take the initiative of enacting a smoking ban to protect her citizens from the harmful effect of tobacco. Several other countries have done the same in the past, these include the United Kingdom, Canada, Norway, France, Italy, Australia, Finland, New Zealand, Most states of the USA, Egypt, Uganda, to mention a few.
Safeguarding the health of the citizens is the responsibility of any people-oriented government. The ban of smoking in public places is one of the proven ways of controlling tobacco consumption and reducing tobacco- related diseases and deaths.
Over 167 countries are signatories to the World Health Organisation Framework Convention on Tobacco Control (WHO FCTC), which is a treaty with several articles aimed at achieving global tobacco control. Nigeria who ratified the FCTC guidelines in 2004 is presently yet to pass the tobacco control bill and also lacks a comprehensive tobacco control structure.
Smoke-free environment helps to de-normalise tobacco smoking, protects non-smokers from the harmful effects of secondhand smoke and helps current smokers to consider quitting. Consequently, individuals, government and insurance companies would spend less income treating tobacco-related diseases.
The products of the tobacco industry are generally known and even self-acclaimed to be addictive and injurious to one’s health, causing several health conditions. In simple terms, the tobacco industry is a threat to the health sector of any country. Therefore, a comprehensive tobacco control structure should be put in place to control tobacco consumption in Nigeria.
Arguments such as unemployment that could result from the enactment of smoke-free public places legislation are largely baseless. This is because it’s been widely reported that enforcement of this ban in other countries has shown no negative economic impact and infact some economic gains were noted in the long term. Conversely, such countries have experienced a significant drop in the smoking population and an evidence-based improvement in the health of the citizens.
As a nation, our true asset is our health and this should be guarded jealously. Let’s prevail on the National Assembly to pass the Nigeria National Tobacco Control Bill before the expiration of this current dispensation. It’s a new year and we could take a cue from Spain!
Dr. Olusegun Owotomo
An Independent Tobacco Control Activist Based in Lagos, Nigeria

WARNING: Secondhand Smoking Kills Too.

About two months ago, I walked into a restaurant located somewhere in Lagos to pick up a bowl of Fish soup. While my soup was being prepared, I noticed a group of white folks seated in a round table and smoking cigarettes. Amidst them were two black guys and a half-caste little girl who was coughing and sneezing repeatedly. This little girl, my humble self, other customers and workers in this restaurant, were all at risk of the harmful health effects of secondhand smoking.

The smoke that comes from the burning end of a cigarette or that is expelled to the air by a smoker is referred to as Secondhand Smoke. The inhalation of secondhand smoke otherwise known as Passive Smoking is a very significant public health hazard.

About a third of the world population is exposed to the dangers of secondhand smoking and annually, thousands of deaths have been linked to this hazard. Those at particular risk are workers and people that hang out in bars and restaurants, children and pregnant women.

Secondhand Smoke contains about 4000 chemicals that are harmful to health. 69 of these chemicals are carcinogens (cancer- causing) and others are toxins that have been scientifically proven to cause various diseases in humans and even animals. They include hydrogen cyanide, carbon monoxide, formaldehyde, acetaldehyde, tar, benzene, ammonia e.t.c.

Diseases caused by these chemicals range from cancers (lung,, bladder, breast, leukaemia e.t.c), respiratory diseases(chronic bronchitis, emphysema e.t.c), coronary artery disease and stroke, to middle ear infections, sudden infant death syndrome, aggravation of asthma in children and miscarriages and stillbirths in pregnant women and erectile dysfunction in men.

There are no safe limits to exposure to secondhand smoke. Children are very vulnerable because of their poorly developed immune system. They are not only exposed at bars and restaurants, they are also exposed when they live with people that smoke. This is because the chemicals in Secondhand Smoke can stick to clothes, hair, nails, skin and even cars (for several months), and children and pregnant women can easily acquire these chemicals from a smoker.

Studies have shown that 13% of all middle ear infections in children are caused by secondhand smoking. Passive Smoking increases the risk of coronary artery disease by 30%, and also increases the risk of lung cancer and stroke. 3000 non-smokers die every year from lung cancer caused by Secondhand Smoking. Carbon monoxide in Secondhand Smoke is a known cause of growth retardation and developmental toxicity in unborn babies. Similarly, benzene causes chromosomal abnormalities in fetuses.

Since smokers are responsible for their health inspite of their knowledge of the health damaging effects of tobacco smoking, the health of non-smokers should be protected not only by the smokers but also by the law.

The World Health Organisation (WHO) through the Framework Convention on Tobacco Control (FCTC) has come out with some guidelines to help protect us from the harmful effects of Secondhand Smoking. These guidelines are part of the articles of the FCTC, which is a treaty with 168 countries (Nigeria inclusive) as signatories.

Several countries are protecting their citizens through effective legislation and enforcement of the FCTC articles to achieve 100% smoke-free public places. Top on the list of such countries are Norway, United Kingdom, Canada, Australia, USA, Italy, New Zealand e.t.c. In Africa, South Africa, Kenya, Ghana and Uganda have been able to enact smoke-free policies, though the enforcement of these policies are still relatively weak. Similarly in Nigeria, the FCT, Osun state and Lagos state have all enacted smoke-free legislation sometimes in the past, the enforcement of these legislation is extremely weak.

Generally speaking, Nigerians are still exposed to dangers of Secondhand Smoking as the Nigerian National Tobacco Bill (NTCB) is still pending in the National Assembly and yet to be passed into law.

Naturally, the Tobacco industry is opposed to the passage of this Bill and will continue to benefit tremendously from its delayed passage, all at the expense of the health of Nigerians (smokers and non-smokers).

Several arguments have been brought forward to oppose the enactment of this Bill. One of such is the issue of unemployment that could arise from an enforcement of 100% smoke-free public places. Evidence based research in countries where these laws have been enacted shows that it doesn’t portend any negative economic impact and some long-term economic gains were even noted.

Conversely, evidence shows that smoke-free legislation reduces the number of hospital admissions for heart disease. A study carried out at the University of California, USA in 2009, shows a 15% decline in heart-attack hospitalizations in the first year after smoke-free legislation was passed, and 36% after three years. A similar study also shows that women, non-smokers, and people under age 60 had the most heart attack risk reduction, with many of those benefiting being hospitality and entertainment industry workers.

Double ventilation and Designated smoking rooms are other alternatives that are suggested by the Tobacco industry. Studies have shown that all these are ineffective in reducing the harm caused by Passive Smoking, as the Secondhand Smoke sticks to surfaces and leave toxins behind for several months. Also, smoke travels from smoking sections to non-smoking sections of restaurants and bars, leaving both staff and customers unprotected. Workers at Designated Smoking rooms would still be at risk and there is no adequate ventilation system in the world that can completely remove Secondhand Smoke. The fact that people cannot see or smell secondhand smoke does not guarantee their protection against its dangers.

This brings me to the story of Heather Crowe, who suffered from Lung cancer and died in 2006, at the age of 57. She worked for several years as a Waitress in a Canadian Restaurant and was exposed to Secondhand Smoking for that long. Shortly after she was diagnosed, she pioneered a nationwide campaign against Secondhand Smoking. Today, Canadian citizens are protected from the deadly claws of Secondhand Smoking by the effective legislation and enforcement of 100% smoke-free public places.

The importance of the effective passage and enforcement of the Nigerian National Tobacco Control Bill cannot be overemphasized. We all have a role to play, our Legislators have within their hands, the power to save our generation from the scourge of the Tobacco industry. The Government has a huge responsibility in protecting our children, pregnant women, workers at bars and restaurants and the entire population from the dangers of Secondhand Smoking. The clock is ticking and more lives are being lost if no action is taken.

Dr. Olusegun Owotomo is an Independent Tobacco Control Activist Based in Lagos,Nigeria.

BBA All Stars: Why the smoke?

BBA All Stars: Why the smoke?

The 5^th season of the Big Brother Africa (BBA) Reality TV show came on live on July 18, with millions of viewers all across the globe. While some are really having fun watching, others are of the opinion that this season’s edition is not as interesting as the previous ones.

I fall in the category of those that have particularly busy schedules, but on a few occasions, I have had the chance to tune in to channel 198. I remember the first time I tuned in to watch this season’s show, what really caught my attention was the three ladies, (Sheila, Meryl and Lerato) playing cards and smoking cigarettes. Subsequently as I watched the program, I realized that cigarette smoking was the norm in the BBA house, as virtually all the house mates smoke (directly or indirectly).

Well, could it be that the house-mates are enjoying their freedom and simply expressing themselves, or could there be more to it? Would it be wrong for us to assume that the BBA house is gradually becoming an avenue to market or communicate some habits to the youths? Could this be a strategy by an industry to increase its market and perhaps could probably be one of the sponsors of this show!

It was once said that “Tobacco smoking is a communicated disease” and smoking in the BBA house sends lots of messages to the viewers, who are mostly youths.

Whether knowingly or unknowingly, directly or indirectly, the organizers of the BBA show are playing a role in assisting the tobacco industry’s attempt to replace half of the current smokers who will die prematurely from tobacco-related deaths, with youths.

When the act of smoking is freely displayed as in the case of the BBA house or in form of product placement in movies, it helps to normalize tobacco smoking thereby making it socially acceptable; one of the factors that influence tobacco smoking among the youths.

Communication Experts have established that one of the best ways to sell a product or habit to the youths is through the mass media, particularly when such products or habit is mixed with pleasure, strong emotions or entertainment. So undoubtedly, the open display of smoking in the BBA house would have a tremendous effect on the social acceptability of tobacco smoking by the youths.

Since direct advertisements and sponsorships by the tobacco industry is gradually phasing out in most countries, the industry looks for other avenues to indirectly market this “deadly stick” that fetches them billions of dollars, but kills 5.4 million people annually.

The fact that Tobacco kills cannot be over-emphasized. Annually, Tobacco kills more people than HIV, Tuberculosis and Malaria combined. An average smoker starts to smoke during his teen years and continues to do so all through his productive years. With time, Tobacco-related diseases set in and require an avoidable expense for their management. These diseases can eventually result in a premature death, ending a life (purpose) and leaving loved ones bereaved.

The control of Tobacco smoking is a very big issue that requires the attention of everyone. It is a public health problem; a threat to our very existence.

The WHO, other Intergovernmental bodies, NGO’S and the Government are working assiduously to achieve a global tobacco control.

The WHO FCTC and its articles is one of the efforts aimed at achieving global tobacco control. In Nigeria, it is in form of the Nigerian National Tobacco Control Bill (NNTCB), which is still pending in the National Assembly and yet to be passed into law. The effective passage and enforcement of this Bill will not only go a long way in controlling Tobacco smoking, but will also improve the health of all Nigerians.

Finally, while we await the passage of the Bill by the National Assembly, we can contribute our own quota by knowing and believing that Tobacco kills, refusing to be cheated on and guarding our health jealously, because that indeed is our true wealth.

Tobacco Control Bill: Let Nigerians know the truth.

Tobacco Control Bill: Let Nigerians know the truth.

It is an established fact that tobacco consumption is a major cause of death worldwide. Unlike HIV/AIDS, malaria, and tuberculosis that are caused by microorganisms, tobacco - related diseases are man-made.

The Vector (tobacco industry, causing the tobacco epidemic) produces agents (tobacco products) that cause immediate pleasurable effects to the host (humans) followed by short and long term devastating health consequences. . Some of the tobacco-related diseases include lung cancer and some other cancers, chronic obstructive pulmonary disease (chronic bronchitis and emphysema), stroke, ischaemic heart disease, impotence to mention but a few.

Globally, tobacco causes about 5.4 million deaths yearly compared to 3 million, 2 million and 1 million deaths caused by AIDS, tuberculosis and malaria respectively. Thus, tobacco causes almost the same number of deaths as malaria, tuberculosis and AIDS combined.

Ironically, the global funding of tobacco control, according to WHO, is below $400 million compared to $18 billion for AIDS, $2.5 billion for tuberculosis and around $2 billion for malaria. As a result, while there has been a gradual decrease in the incidence of AIDS, tuberculosis and malaria, tobacco-related deaths have been on a sharp increase.

The WHO FCTC (Framework Convention on Tobacco Control) is a treaty with an overall objective of protecting present and future generations from the devastating health, social, environmental and economic consequences of tobacco consumption and exposure to tobacco smoke; and to reduce continually and substantially the prevalence of tobacco use and exposure to tobacco smoke.

The domestication of the WHO FCTC by most developed countries to protect their citizens from the harmful effects of tobacco, has translated to marked reduction in tobacco consumption in these countries. The effect of which is the migration of tobacco companies to developing countries where there is no effective legislation to curb their activities.

The components of the FCTC include; taxation on tobacco products that is continuously adjusted to the annual inflation rate, smoke-free public places, health warnings on tobacco products-to include pictures or pictograms on cigarette packages, ban on advertisement, promotion or sponsorships by tobacco companies, regulation of tobacco products, tobacco products disclosures e.t.c.

About 168 countries including Nigeria are signatories or parties to the FCTC. While Nigeria is yet to fully domesticate the FCTC, South Africa, a fellow African country has one of the most comprehensive tobacco control policies in the world.

The Nigeria National Tobacco Control Bill which is one of the efforts geared towards the domestication of the FCTC in Nigeria will soon be presented to the House plenary session by the Senate Committee on health.

The tobacco industry is the major challenge to the FCTC implementation. The industry comes up with different tactics to frustrate the passage of a bill such as this. One of their strategies is to come up with erroneous arguments either directly or indirectly by lobbying legislators, scientists and even journalists to counter the passage of the anti-smoking bill.

Several evidence-based researches have been conducted to nullify some of the arguments of the tobacco industry. One of such is a research conducted by Tei-Wei Hu et al, on the role of taxation in tobacco control and its potential economic impact in China. The result clearly states that increasing the tobacco tax in China is the most cost-effective instrument for tobacco control. He established that a tax of $0.13 per pack of cigarettes would decrease cigarette consumption by 3 billion packs of cigarettes, reduce number of smokers by 3.42 million, save 1.14 million lives and increase the Chinese government revenue by $17.2 billion. The effect of increased tobacco taxation on employment was minimal.

Similarly, studies in the USA, UK and Indonesia, using their national input/output industry tables, showed that a cigarette tax increase led to gain in income and employment in other sectors, greater than the loss in the true tobacco sector.

Increased tobacco taxation also leads to an increase in government revenue which can in turn be used in sponsoring tobacco control programs in form of dedicated tobacco tax. The effect of this is a reduction in the smoking population and an overall improvement in the health of Nigerians. However, concrete steps should be taken by the government to continuously adjust tobacco taxation to the annual inflation rate and to guide against illicit tobacco trade (smuggling), which can neutralize the tobacco control measure of a tax increase.

Revenue derived from tobacco taxation can also be used to provide alternative employment for tobacco farmers, who are already exposed to a lot of occupational hazards like Green tobacco sickness. Crop diversification is the best alternative for these tobacco farmers. Government can assist them in cultivating food crops that will boost food production in the country, alleviate poverty, and provide more income for the farmers. This generates more revenue for the government and it is more economically productive when compared to tobacco farming with its attendants direct and indirect health costs.

Another component of the FCTC is the enforcement of smoke-free public places. This is yet another measure that has been proven to help reduce the smoking population. This policy helps protect non-smokers including pregnant women and children from the harmful effects of passive smoking (second hand smoking). It also helps to “denormalise” tobacco smoking, which some of our youths see as the norm. Similarly, it reduces the number of cigarettes smoked per smoker, since there would be fewer smoking areas.

The implementation and enforcement of the Nigerian National Tobacco Control Bill is the best thing the National Assembly can do to improve the health of Nigerians in this century. The passage of this bill is just the beginning of the struggle to save Nigerians from the harmful effects of tobacco, because the tobacco industry will fight back in diverse ways. Adequate measures should be put in place for monitoring, evaluation and surveillance, for effective coordination of the various components of the bill and the actualization of the intended objectives.

Furthermore, government will need to collaborate with tobacco control programs and other Non-governmental Organisations in the implementation of certain components of the FCTC such as in educating the masses and creating awareness about the harmful effects of tobacco; provision of smoking cessation clinics for those that want to quit smoking and also sponsorship of research work on tobacco control particularly in the areas of monitoring and evaluation. In addition, achieving a great impact in the area of tobacco control in Nigeria requires an effective and efficient coordination of all tobacco control activities.

Tobacco consumption and exposure to tobacco smoke (passive smoking) can cause premature deaths. All stakeholders should support the implementation and enforcement of this bill to help prevent our youths from starting a health-damaging behavior; help current smokers quit; protect non-smokers including children and workers at bars and restaurants from the harmful effects of second hand smoking; generally improve the health of Nigerians and prevent millions of deaths globally.